I understand, but look at it this way.. I have seen more and more local EMS arriving with tourniquets lately because of someone has read or heard tourniquets are in style. Remember, once a tourniquet is applied all blood supply is ceased below or distal to the wound. Meaning you have decided for amputation for anything below that site.
Understand that in cath labs (albeit a nice clean puncture) arterial bleeding is routine. It takes a lot of pressure to push down on a pressure point and "clamp it down" to cease blood flow. That is why they usually have a large tech hold weight and pressure for at least 5-10 minutes, then we place a "mechanical clamp" ( looks like a C clamp) on the site or sand bags for hours without movement. Still then there is a chance of internal bleeding and cause of a hematoma. Applying pressure to pressure points is NOT as easy as one thinks because it takes a deep continuous pressure (especially in the femoral area) and a lengthy amount of time, that many do not realize. You are basically squeezing the artery shut, causing cessation of blood supply of that specific artery (not all blood supply, such as the use in tourniquets).
I am not saying tourniquets are never necessary, especially for those specific wounds they see in a war zone. However; the lacerations, avulsions, pedicle tears, we routinely see in civilian trauma can almost be always be stopped by simple methods direct pressure and pressure bandages.
Projectory wounds that have shrapnel and multiple "tumbling" effect causes multiple deep tissue injuries sites, along with multiple arterial tears and lacerations. These types of explosions are most commonly from IED type devices, and it is not unusual to receive partial to complete amputations of the extremities. Other routine associated injuries are deep imbedment of shrapnel into cavities such as the chest, abdomen and cranial vaults.
I have discussed with those over there (medics, nurses, physicians) the type of wounds, some newer treatment regime and outcomes. Tragically, the only good thing about war, is that we learn how to decrease morbidity and increase trauma care ten fold than in civilian peace time.
I am very impressed on many of the learned trauma care. I am excited of some of the progression we are learning. Especially new traumatic brain injury (TBI) treatments of actually making a window (removing part of the skull and implanting into an abdominal wall to allow blood circulation to the skull portion) to allow cerebral edema to occur and when the edema reduces, placing the skull portion back on. Other treatment od chest wounds, repairing of organs and other radical treatments that would took decades to develop and test in civilian peace time.
Again, I am amazed of what, how, is being learned and tested and as well honor those that are developing new and radical treatments to save lives and the sacrifices of those that received such wounds and injuries.
Yes, it may be that we see tourniquets are the new way to control bleeding in multiple type injuries. I don't doubt it. Yet, we need to see exactly what protocol and regime they were best used on. Unfortunately most learned treatment will be a few years from now, before it is considered to be placed into the private world. Until then be sure, we follow steps that are in the curriculum and considered standard of care.
R/r 911
